[Congressional Record Volume 150, Number 69 (Monday, May 17, 2004)]
[Senate]
[Pages S5536-S5537]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. NELSON of Nebraska (for himself and Ms. Collins):
  S. 2426. A bill to amend title XVIII of the Social Security Act to 
clarify the treatment of payment under the medicare program for 
clinical laboratory tests furnished by critical access hospitals; to 
the Committee on Finance.
  Mr. NELSON of Nebraska. Mr. President, today I introduce legislation 
that will overturn a new regulation that is putting critical access 
hospitals (CAH) at risk by arbitrarily lowering the Medicare 
reimbursement for laboratory services. Sixty rural hospitals in 
Nebraska will be negatively impacted unless this legislation is 
reversed.
  This legislation would repeal a Center for Medicare and Medicaid 
Services' (CMS) regulation that would prohibit critical access 
hospitals from being reimbursed at-cost for laboratory services, unless 
patients are ``physically present in a critical access hospital'' when 
laboratory specimens are collected. Many CAHs provide laboratory 
services in rural health clinics (RHCs) and nursing homes in smaller, 
neighboring communities, as well as in home-health settings; however, 
the elimination of cost-based reimbursements may make it prohibitive 
for them to continue offering off-site laboratory testing. In short, 
under the new regulation, lab services would not be reimbursed by CMS 
unless the patient is at the facility where testing will occur.
  This change jeopardizes rural Americans' access to care by imposing 
an additional burden on the frail elderly by requiring them to visit 
the hospital to get simple lab tests done. The additional time and 
expense incurred by the patient is unnecessary if the CAH is willing 
and able to conduct tests at the point of patient care and transport it 
back to the hospital for analysis.
  Congress created the CAH program in 1997 to ensure that those in 
isolated, rural communities have access to health care. To protect the 
viability of these hospitals, often a community's only source of vital 
health care services, Congress established cost-based reimbursement for 
Medicare inpatient and outpatient services--regardless of where the 
services are provided. The new regulation would fundamentally alter 
this well-established practice.
  We have tried to work with CMS to change the rule. In November of 
2003, I was joined by 28 Senators in a bipartisan letter to the 
Administrator of CMS asking for his assistance in constructing a rule 
that does not penalize CAHs for offering off-site laboratory services. 
Unfortunately, CMS responded that the rule would stay intact.
  I am pleased to be joined in this effort by Senator Susan Collins. 
Senator Collins has been a strong advocate for rural health care, and I 
look forward to working together on this legislation.
  The Nebraska critical access hospitals affected by the regulation 
are:

       Harlan County Health System in Alma, Fillmore County 
     Hospital in Geneva, Pawnee County Memorial Hospital in Pawnee 
     City, Niobrara Valley Hospital Corporation in Lynch, Thayer 
     County Health Services in Hebron, Kimball County Hospital 
     in Kimball, Kearney County Health Services/Hospital in 
     Minden, Saunders County Health Services in Wahoo, 
     Henderson Health Care Services in

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     Henderson, Community Memorial Hospital in Syracuse, Garden 
     County Hospital & Nursing Home in Oshkosh, Franklin County 
     Memorial Hospital in Franklin, Genoa Community Hospital in 
     Genoa.
       Gothenburg Memorial Hospital in Gothenburg, Annie Jeffrey 
     Memorial County Health Center in Osceola, Brodstone Memorial 
     Nuckolls County Hospital in Superior, Webster County 
     Community Hospital in Red Cloud, Tilden Community Hospital in 
     Tilden, Morrill County Community Hospital in Bridgeport, 
     Jefferson Community Health Center in Fairbury, Memorial 
     Hospital in Aurora, Oakland Memorial Hospital in Oakland, St. 
     Francis Memorial Hospital in West Point.
       Alegent Health Memorial Hospital in Schuyler, Nemaha County 
     Hospital in Auburn, Brown County Hospital in Ainsworth, 
     Antelope Memorial Hospital in Neligh, Cozad Community 
     Hospital in Cozad, Litzenberg Memorial County Hospital in 
     Central City, Avera St. Anthony's Hospital in O'Neill, Warren 
     Memorial Hospital in Friend, Creighton Area Health Services 
     in Creighton, Butler County Health Care Center in David City, 
     Rock County Hospital in Bassett, Boone County Health Center 
     in Albion, Callaway District Hospital in Callaway, York 
     General Hospital in York.
       Howard County Community Hospital in St. Paul, Memorial 
     Hospital CAH in Seward, Dundy County Hospital in Benkelman, 
     Chadron Community Hospital Health Services in Chadron, St. 
     Mary's Hospital in Nebraska City, West Holt Memorial Hospital 
     in Atkinson, Cherry County Hospital in Valentine, Providence 
     Medical Center in Wayne, Plainview Public Hospital in 
     Plainview, Osmond General Hospital in Osmond, Tri Valley 
     Health System in Cambridge, Pender Community Hospital in 
     Pender.
       Johnson County Hospital in Tecumseh, Chase County Community 
     Hospital in Imperial, Community Medical Center in Falls City, 
     Valley County Hospital in Ord, Crete Area Medical Center in 
     Crete, Ogallala Community Hospital in Ogallala, Perkins 
     County Health Services in Grant, Memorial Health Center in 
     Sidney, Gordon Memorial Hospital District in Gordon, Memorial 
     Community Hospital in Blair, Box Butte General Hospital in 
     Alliance.
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